1. Introduction

Rabies is one of the most important neglected zoonotic diseases worldwide and remains a major public health concern despite being entirely preventable. It is caused by rabies virus (Lyssavirus genus) and affects all mammals, with domestic dogs serving as the principal reservoir responsible for more than 95% of human rabies cases globally. Once clinical signs develop, rabies is almost invariably fatal; however, human deaths can be prevented through timely post-exposure prophylaxis (PEP) and interruption of transmission through effective dog vaccination programs. The continued global burden of rabies is largely associated with inadequate dog vaccination coverage, limited access to PEP, weak surveillance systems, and insufficient collaboration between human and animal health sectors, particularly in low- and middle-income countries (Hampson et al., 2015; WHO, 2023).

Rabies remains a significant health challenge in Africa, where dog-mediated transmission continues to cause thousands of human deaths annually. The burden is likely underestimated due to incomplete surveillance, limited laboratory confirmation, and underreporting of cases, particularly in rural areas where access to healthcare and veterinary services is limited. Domestic dogs play a central role in maintaining transmission cycles, and livestock infections mainly occur as spillover events following contact with infected dogs. The economic impact of rabies extends beyond human health through livestock mortality, costs associated with PEP provision, vaccination campaigns, and disease control activities. Global rabies elimination initiatives, including the “Zero by 30” strategy, emphasize that dog-mediated human rabies can be eliminated through sustained mass dog vaccination, improved surveillance, community awareness, and strengthened One Health coordination among veterinary, medical, and public health sectors (WHO, FAO, 2018; WOAH, 2023)

Ethiopia is among the African countries where rabies remains endemic and continues to affect both animal and human populations. The disease has been reported in different regions of the country, with domestic dogs identified as the major reservoir and source of infection. Human rabies exposures in Ethiopia are predominantly associated with dog bites, while continued transmission is influenced by free-roaming dog populations, inadequate dog vaccination coverage, delayed healthcare-seeking behavior, limited availability of PEP, and gaps in disease surveillance. Recent studies in Ethiopia have highlighted that although rabies prevention activities have been implemented, inconsistent vaccination campaigns and weak integration between veterinary and public health services remain major barriers to effective control (Gelgie et al., 2022; Woldegeorgis et al., 2023)

The Amhara Region is one of the areas of Ethiopia where rabies remains an important zoonotic disease, with frequent reports of animal rabies outbreaks and human exposure cases. The region’s mixed crop–livestock production system, high level of interaction between humans, dogs, and livestock, and variable access to veterinary and health services create favorable conditions for rabies persistence. Previous studies conducted in Ethiopia have demonstrated considerable spatial and temporal variation in rabies occurrence, which is associated with differences in dog population dynamics, vaccination coverage, community awareness, surveillance capacity, and implementation of control measures (Erkyihun et al., 2022; Gelgie et al., 2022)

North Shewa Zone, located in the central highlands of Amhara Region, has experienced recurrent rabies outbreaks affecting domestic animals and humans. The zone is characterized by extensive livestock production, mixed farming systems, and frequent contact between free-roaming dogs, livestock, and human communities. Despite repeated occurrence of rabies outbreaks, comprehensive epidemiological information describing disease magnitude, temporal and seasonal patterns, affected animal species, geographic distribution, dog vaccination coverage, and human rabies exposure trends remains limited. Such information is essential for identifying risk periods and high-risk areas, improving resource allocation, and designing effective local rabies prevention and control strategies.

Retrospective epidemiological studies using routine surveillance data provide important evidence for understanding disease patterns and evaluating the effectiveness of existing control interventions. Analysis of animal rabies occurrence, human exposure trends, vaccination coverage, and spatial distribution can support evidence-based decision-making and strengthen One Health approaches. In endemic areas, where resources are limited, identifying priority interventions such as targeted dog vaccination, improved surveillance, timely outbreak response, and community engagement is critical for reducing rabies transmission.

2. Statement of the Problem

Rabies remains an important public and veterinary health challenge in Ethiopia despite the availability of effective preventive measures. In North Shewa Zone, Amhara Region, the disease continues to affect humans and animals, with domestic dogs acting as the primary reservoir and source of transmission. Persistent rabies transmission is driven by inadequate dog vaccination coverage, limited community awareness, weak surveillance systems, insufficient laboratory confirmation, and gaps in One Health coordination. The frequent interaction between humans, dogs, and livestock within the mixed crop–livestock production system further increases the risk of disease spread. However, comprehensive epidemiological data on rabies occurrence, seasonal and spatial patterns, human exposure, and dog vaccination performance in North Shewa Zone remain limited. This lack of evidence constrains the development of targeted and effective rabies prevention and control strategies. Therefore, this study was conducted to characterize the epidemiology of animal and human rabies and assess dog vaccination coverage in North Shewa Zone, Amhara Region, Ethiopia, from 2020 to 2024.

2. Material And Methods

2.1. Description of the Area

The study was conducted in North Shoa Zone, Amhara Region, Ethiopia. It is located 130 km northeast of Addis Ababa. The zone is situated between latitudes 8°38′–10°42′ N and longitudes 38°40′–40°03′ E. Covering an area of 16,172.52 km², the zone is bordered by Oromia to the south and west, South Wollo to the north, Oromia Zone to the northeast, and Afar Region to the east. The zone has 23 districts and 303 Village kebelas and 7 rural towns. The zone also has livestock infrastructure, 343 kebele vet posts and 23 district vet clinics, 93.6% area coverage, and 85.4% service for the whole zonal community. The area receives annual rainfall with a bimodal distribution, typically ranging from 400- 700 mm, and its elevation is 1290- 3000 m above sea level. Three agro-ecological zones: lowland (<1800 m, 34.2%), mid-altitude (1800–2400 m, 28%), and highland (>2400 m, 37.8%). According to North Shoa Livestock Development Office, the area is characterized by a crop-livestock mixed farming system. The livestock population in the zone is substantial, with approximately 1.7 million cattle, 2.5 million sheep, 0.4 million equines, and 115,347dog population. The zone has an estimated population of over 2.2 million People. Over 88% of the population is rural, relying heavily on agriculture, while the remainder lives in urban centers.

2.2. Study Population

The study population included animal and human populations from rabies-affected districts of North Shewa Zone, Amhara Region, Ethiopia, during 2020–2024. The animal population comprised susceptible domestic species, including dogs, cattle, sheep, goats, and equines, identified through routine animal health surveillance records. The human population included individuals exposed to suspected or confirmed rabid animals. Inclusion of both populations enabled assessment of rabies epidemiology, zoonotic transmission patterns, and public health implications within the mixed crop–livestock production system of the study area.

2.3. Study Design

A retrospective descriptive epidemiological study was conducted to assess the occurrence and distribution of animal and human rabies in North Shewa Zone, Amhara Region, Ethiopia, from 2020 to 2024. The study utilized routinely collected secondary surveillance data from the North Shewa Zone Livestock Office and public health department to evaluate temporal and spatial patterns, affected animal species, human rabies exposures, and dog vaccination coverage. Relevant scientific literature, government reports, and institutional records were also reviewed to support interpretation of the findings.

2.4. Source of Data

Data were obtained from multiple secondary sources. Animal rabies data, including outbreak reports, animal cases and deaths, surveillance records, and dog vaccination data, were collected from the North Shewa Zone Livestock Office through the Disease Outbreak and Vaccination Activity Report (DOVAR) system and district veterinary offices. Data on human rabies exposures were obtained from the North Shewa Zone Health Department. In addition, relevant scientific literature, government reports, and technical documents were reviewed to provide contextual information and support the interpretation of epidemiological findings. Before analysis, all datasets were checked for completeness, consistency, and accuracy to ensure data quality.

2.5. Data Management and Analysis

Data were entered into Microsoft Excel 2019, cleaned, coded, and analyzed using Stata (version 14). Data quality was ensured through checks for completeness, consistency, and accuracy before analysis. Descriptive statistics, including frequencies, percentages, morbidity, mortality, case fatality rate (CFR), and dog vaccination coverage, were calculated using standard epidemiological methods (Thrusfield, 2005).Temporal trends in rabies outbreaks, animal cases, deaths, human rabies exposures, and dog vaccination coverage from 2020 to 2024 were assessed. Spatial distribution across districts and epidemiological patterns by animal species, year, district, and vaccination status were examined using descriptive summaries and cross-tabulations. Results were presented in tables, graphs, and maps to describe the temporal and spatial epidemiology of rabies in the study area.

2.5. Case Definitions According to the standard case definition of WHO

Human rabies exposure can be classified into possible exposure, probable exposure and exposed:

a) Possible exposure: A person who had close contact (usually a bite or scratch) with a rabies-susceptible animal in (or originating from) a rabies-infected area.

b) Probable exposure: A person who had close contact (usually a bite or scratch) with an animal displaying clinical signs consistent with rabies at the time of the exposure, or within 10 days following exposure in a rabies-infected area.

 c) Exposed: A person who has had close contact (usually a bite or scratch) with a laboratory-confirmed rabid animal

3. Result
   1. Temporal distribution

During 2020–2024, rabies outbreaks were reported in 9 of the 23 districts of North Shewa Zone, with a total of 34 outbreaks recorded and an overall outbreak occurrence of 22.5%. The distribution showed substantial annual variation, with the highest number of outbreaks observed in 2022 (15 outbreaks; 44.2%), followed by 2021 (8 outbreaks; 23.5%) and 2020 (6 outbreaks; 17.6%). Outbreak occurrence declined markedly in 2023 and 2024, with only 1 (2.9%) and 4 (11.8%) outbreaks recorded, respectively. Across affected districts, outbreak numbers ranged from 2 to 7 during the study period, demonstrating that rabies transmission was concentrated in specific districts but remained persistent over time, with peak activity occurring in 2022 (Table 1 and Figure 2).

Table 1: Annual distribution and proportion of reported rabies outbreaks across 23 districts and 364 kebeles in North Shewa Zone, Ethiopia, 2020–2024

Figure-1 the location of the study area north showa zone districts/ districts

Figure 2: Number of Rabies disease outbreaks by year in North Shewa Zone, Ethiopia, from 2020 to 2023

3.2. Monthly Distribution of Animal Rabies Cases and Deaths

From 2020 to 2024, a total of 170 animal rabies cases and 168 deaths were recorded among 25,934 animals at risk, corresponding to overall morbidity, mortality, and case fatality rates (CFR) of 0.66%, 0.65%, and 98.8%, respectively. Rabies cases were reported in 10 months of the year, with no cases recorded in April and December. A clear seasonal pattern was observed, with cases increasing from June (13 cases), reaching the highest level in August (55 cases; 32.4%), and remaining elevated during September (27 cases) and October (31 cases). Although August had the highest case and death counts, the maximum monthly morbidity and mortality rates occurred in September (3.37%), likely due to the lower population at risk. The CFR was consistently high, reaching 100% in all months except July (92.0%). Overall, most rabies cases occurred during the long rainy and early dry seasons (June–October), highlighting the need for intensified surveillance and preventive measures, particularly timely mass dog vaccination campaigns before peak transmission periods (Table 2 and Figure 3).

Table 2: Monthly distribution of reported animal rabies cases and deaths in North Shewa Zone, Ethiopia, 2020–2024

Figure 3: monthly distributions of animal rabies outbreak in North Shewa Zone during 2020–2024

3.3. Seasonal distribution of animal rabies cases and deaths

Animal rabies occurrence showed a distinct seasonal pattern during the study period. The majority of cases were recorded during the long rainy season (June–August), with 93 cases (54.7%) and 91 deaths, followed by the early dry/cold season (September–November), which accounted for 63 cases (37.1%) and 63 deaths. In contrast, fewer cases occurred during the dry/hot season (December–February) and short rainy season (March–May), contributing 8 (4.7%) and 6 (3.5%) cases, respectively. Overall, 91.8% of all rabies cases occurred between June and November, indicating increased transmission during the rainy and post-rainy periods. These findings highlight the need to strengthen surveillance and implement preventive interventions, particularly mass dog vaccination, before the onset of high-risk seasons (Table 3 and Figure 4).

Table 3: Seasonal distribution of reported animal rabies cases and deaths in North Shewa Zone, Ethiopia, 2020–2024

Figure 4: Rabies disease outbreaks by season in the North Shewa Zone, Ethiopia, from 2020 to 2024

3.4. Animal Rabies Case, Death and CFR by Years (2020- 2024) in the last five years

Between 2020 and 2024, a total of 170 animal rabies cases and 168 deaths were reported among 25,934 animals at risk in North Shewa Zone, resulting in an overall morbidity rate of 0.66%, mortality rate of 0.65%, and an exceptionally high case fatality rate (CFR) of 98.8%. Annual disease occurrence varied considerably over the study period. The highest annual morbidity and mortality rates were recorded in 2024, with 94 cases and 83 deaths among 3,250 animals at risk, corresponding to 2.89% morbidity and 2.55% mortality, despite a lower CFR (88.3%) than in previous years. In contrast, 2022 recorded 73 cases and 73 deaths, with the highest CFR of 100%, while 2023 had the lowest disease occurrence, with only 4 cases and 4 deaths (0.16% morbidity and mortality). The CFR remained extremely high throughout the study period, reaching 100% in 2020, 2022, and 2023, and 95.2% in 2021, indicating that nearly all clinically affected animals died. Overall, these findings demonstrate marked year-to-year variation in rabies occurrence while confirming the almost invariably fatal nature of rabies once clinical signs develop. (Table 4)

Table 4: Number of reported rabies cases, deaths, and case fatality rate in North Shewa Zone, Ethiopia, 2020–2024

3.5. Animal Rabies Cases and Deaths by Species

Among animals, the highest animal rabies cases were recorded in dog (n = 132; 77.6%), followed by equine species (n = 15; 8.8%). The lowest animal Rabies cases were recorded in caprine Animal Species (2.4%). Similarly, the highest number of animal deaths due to rabies were recorded in dog (n = 132; 78.6%) while the lowest was recorded (n = 3; 1.8%) in caprine. (Table 5).

Table 5: Distribution of reported animal rabies cases, deaths, and case fatality rate by species in North Shewa Zone, Ethiopia, 2020–2024

3.6. Spatial distribution

A total of 34 rabies outbreaks, 170 animal cases, and 168 deaths were reported across nine districts of North Shewa Zone during 2020–2024. Midda and Moja-Wadera recorded the highest number of outbreaks (7 each), with Midda reporting the highest number of cases and deaths (41 cases and 41 deaths), followed by Moja-Wadera (31 cases and 30 deaths). In contrast, Menz-Gera, and Menz-Lalo reported relatively fewer cases. The overall case fatality rate was 98.8%, with a CFR of100% in seven of the nine affected districts, highlighting the exceptionally high fatality of rabies in the study area. (Table 6).

Table 6: District-level distribution of reported animal rabies cases in North Shewa Zone, Ethiopia, 2020–2024.

A total of 34 rabies outbreaks were reported in 9 districts of North Shewa Zone between 2020 and 2024, involving 25,934 animals at risk. During the same period, 15,858 dogs were vaccinated, resulting in overall vaccination coverage of 61.1%. The annual number of outbreaks increased from 6 in 2020 to a peak of 15 in 2022, before declining to 1 in 2023 and 4 in 2024. Dog vaccination coverage decreased progressively from 65.1% in 2020 to 38.6% in 2023, but increased substantially to 93.5% in 2024. The decline in outbreak numbers observed in 2024 following the marked increase in vaccination coverage suggests that enhanced dog vaccination may have contributed to reducing rabies transmission. Nevertheless, the marked year-to-year variation highlights the need for sustained mass dog vaccination and strengthened rabies surveillance to achieve effective disease control. (Table 7).

Table 7: Annual dog vaccination coverage and rabies outbreaks in North Shewa Zone, Ethiopia, 2020–2024

During 2020–2024, North Shewa Zone reported 34 rabies outbreaks, 170 animal rabies cases, and 887 human rabies exposure cases, with considerable annual variation. The highest outbreak occurrence was recorded in 2022 (15 outbreaks; 44.12%), accompanied by 73 animal cases (42.94%) and the highest number of human exposures (584; 65.8%). In 2024, despite fewer outbreaks (4), animal rabies cases reached the highest level (94; 55.3%) and human exposures remained high (218; 24.6%). The lowest burden was observed in 2023, with one outbreak, four animal cases, and seven human exposures. Overall, the temporal pattern showed a close association between animal rabies occurrence and human exposure, indicating the continued importance of integrated rabies surveillance, timely outbreak response, and sustained dog vaccination programs. (Table 8 and Figure 5).

Table8:  Annual distribution of reported animal rabies cases and human rabies exposures in North Shewa Zone, Ethiopia, 2020–2024.

Figure 5: Rabies disease outbreaks by season in the North Shewa Zone, Ethiopia, from 2020 to 2024